The following was posted by Julie McKinney; Health Literacy List Moderator; World Education; jmckinney@worlded.org on the HealthLiteracy Listserv.

“Michael Villaire from the Institute for Healthcare Advancement has graciously written up some detailed notes about the IOM Health Literacy Roundtable in Los Angeles, CA on November 30th.

Thanks, Michael for sharing this report with us all!”

Julie

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“I was delighted that the Institute of Medicine*s Health Literacy Roundtable partnered with UCLA*s Anderson School of Management to bring a Roundtable meeting out to the west coast, enabling many people who would not normally attend these meetings to do so. Here are a few of my notes from the meeting, entitled *Understanding What Works in Improving Health Literacy Across a State: A Workshop.* An initial caveat: I did not have access to specific PPT presentations, so my notes may have missed details or miscast some information. My apologies in advance if this is the case. I did try to provide a link where I could find one online for more information.

He urged those in health literacy to involve as many stakeholders as possible, both the obvious (patients, providers, policy makers) and the not-so-obvious (media, entertainment, education).

The morning sessions were devoted to *State-based Models to Improve Health Literacy.* Pam Silberman, Dr.PH, President / CEO of the North Carolina Institute of Medicine (no relation) developed a comprehensive statewide program and task force to raise awareness about health literacy and study ways in which it could improve health literacy in North Carolina. She listed the 14 recommendations made by the task force. Among the recommendations: get state Department of Health and Human Services* consumer education materials down to a 7th grade reading level. Of the 14 recommendations, progress had been made on 11. Link:

Arthur Culbert, Ph.D, discussed the Health Literacy Missouri (HLM) experience. He showed HLM*s video and provided statistics on health literacy in the state. He reviewed a number of HLM*s programs and demonstration projects, including YooMagazine, Straight Talk with Your Doc, standardized patients, and more. He discussed HLM*s materials rewrite service, library service, and educating the business community about health literacy. He stressed HLM*s collaborative efforts in helping states start and grow health literacy coalitions, and its cutting edge efforts in social media and health literacy. Link:

The morning concluded with a remote report from Terry Davis, Ph.D, Professor at Louisiana State University. Her message centered around how best to move a health literacy agenda in one*s state. She suggested finding a champion, as she did with Louisiana state legislator Lydia Jackson. Dr. Davis*s effort started with a needs assessment and development of tools, including a teacher*s training manual workshop and materials. The budget was $300k/year for 3 years and targeted FQHCs (Federally Qualified Health Centers). She detailed the effects of hurricanes Katrina and Rita, the extent of devastation on buildings and loss of records, but noted that the effort never faltered.

The afternoon sessions began with Dean Schillinger, M.D., Clinical Medicine Professor at UC San Francisco, who spoke on *How the University Can Advance State Health Literacy.* He described community-engaged research in health literacy, using the National Action Plan to Improve Health Literacy as a rubric. He discussed community-based research projects at UC San Francisco and in the area, including the Bay Area Breast Cancer and Environment Research project as an example of community based research. He dispelled the myth that somehow randomized, controlled trials lead directly to some kind of spontaneous diffusion into practice; thus, the value of community engagement in research. He also briefly discussed the concept of public health literacy, giving an example of a successful campaign: people knowing and understanding that second-hand smoke kills. Link: http://bayarea.bcerc.org/

Next up was Carol Mangione, M.D., MSPH, Professor of Medicine and Health Services at UCLA, speaking on *Workforce Training and Preparedness.* She reviewed some basic health literacy statistics and discussed results from her informal survey of University of California schools to discover the extent of health literacy*s place in health professionals* curricula. She found the results *lacking,* and noted that while some health literacy content was included in various forms, there was no specific course dedicated solely to health literacy. She provided a review of health literacy information from sources such as AMA Foundation, AHRQ, and CDC. Commenting on the most appropriate places for such curricula, she said, *The most obvious place is health communications and health disparities.*

Kicking off the next section, *Improving Health Literacy at the Community Level,* was Rima Rudd, Sc.D, MSPH, Senior Lecturer on Society, Human Development and Health; and Director of Education Programs, Department of Society, Human Development and Health, Harvard School of Public Health. Her talk on *New York City Mayor*s Initiative on Health

Literacy* told a story of collaboration, mutual respect and a participatory model on how synergy can be created when groups bring their strengths to the table, and concentrate more on how they can contribute. She started by discussing how the initiative was preceded by much work and study by such groups as NCSALL (National Center for the Study of Adult Literacy and Learning), the Harvard School of Public Health, and the Literacy Assistance Center of New York City. She told the story of how these groups came together to meet shared goals. Health literacy study circles produced training manuals on navigating healthcare systems, chronic disease management, and screening/prevention. Link:

Next up was Ariella Herman, Ph.D, MS, Research Director, Health Care Institute, Anderson School of Management, UCLA. She told the story of *Improving Health Literacy Through the Head Start Program,* a collaboration among UCLA, Johnson & Johnson, Head Start and the Health Care Institute. The program began with a book, What To Do When Your Child Gets Sick, written by Gloria Mayer, RN, Ed.D, and published by the Institute for Healthcare Advancement, and its Teacher Training Manual.

The Health Care Institute trainings provided the book to parents in a training session; eventually, more units were added and children were involved in learning healthy lifestyle choices. The program included home visits and follow up/reinforcement of learned goals in an effort to empower families, and trainers as well. Pre- and post-results demonstrated a decrease in both clinic and ED use vs. home care; conservative estimates showed a $554 per year savings per family. Link:

Cynthia Solomon, CEO of FollowMe, Inc., described MiVia, an online personal health record, designed to store one*s information and share it securely with those to whom one wishes to grant access, e.g., healthcare providers, family, etc. The site was originally started for migrant agricultural workers, but has been expanded to include vulnerable populations and those without a medical home. Another interesting program, www.healthshack.info, was designed by vulnerable, homeless teens who now serve as program ambassadors and content consultants for the site. Link: https://www.mivia.org/ The final plenary session was from Ellen Beck, M.D., Director of the UC San Diego Student-Run Free Clinic Project and Fellowship in Underserved Health Care. She provided an overview of the creation, mission, objectives and daily operations of the San Diego Student-Run Free Clinic, a collaborative community effort. Innovative aspects of the program include the use of promotoras to teach medical students and creation of a comprehensive wellness program in inner city elementary schools. Link: http://meded.ucsd.edu/freeclinic/

The day concluded with impressions on the day*s agenda from members of the IoM Health Literacy Roundtable. A few of the comments:

Health literacy is local. We were impressed with the state health literacy coalitions* successes, but left feeling a little depressed that they are filling a vacuum, i.e., there would be nothing were it not for these coalitions* efforts.

Though there was talk of changing the healthcare system, the real value comes in empowering patients, rather than just teaching them.

We must begin early and involve parents, kids, and medical students. We didn*t get into this mess overnight; it*s going to take a generation to get out of it.

How do we break down the academic *silos* and infuse real-life experience in medical education. We have a great opportunity to create more such partnerships.”